Could You Recognize Autism in Your Adult Client?

“The problem is that you never come out of your room!” Clark yelled.

It was our first session. Shelly, his wife of 20 years, was sitting approximately two miles away from him on the office couch.

“You know I have anxiety!” she yelled back.

He was an IT professional: she a SAHM. Both had the disheveled and tired look I had seen on dozens of strained couples in my office over the years.

Then Clark said something that made my ears perk up.

“The last time we had sex was four months and 22 days ago, and before that, it was eight months and nineteen days ago, and at the longest it was four years, six months, and twenty-three days, and we are not going back to that!”

Shelly turned beet-red in embarrassment, Clark puffed his chest—and something clicked in my head.

Shortly before Shelly and Clark arrived in my office, both of my young boys were diagnosed, back to back, with autism.

When Clark and Shelly called for counseling, I was still gutted.

I was hollow with grief.

I was going through the motions of therapy, but had barely come up for air: from crying, from researching, from insurance and paperwork and up-all-night panic.

And I was also, suddenly, intensely aware of the autism spectrum everywhere around me.

By week three with Clark, I was 99% sure he had high-functioning autism—formerly known as Asperger’s Disorder.

There were a few early clues. The memory for dates, obviously. His rigidity. His robotic vocal pattern, and tendency to dominate conversation. The inflexible habits—all highly logical—around which he organized his life. The way he noticed fascinating numerical patterns no one else would.

But Clark was no stereotype. He had great eye contact. A twenty-year marriage. A successful career. Children he adored—and all this despite being raised by a volatile and abusive alcoholic mother.

I talked to Clark about my hunch, and through his health care he saw an Autism Spectrum Disorder (ASD) specialist who diagnosed him a “classic case” of high-functioning ASD.

Clark found a support group, read books, and felt a new understanding of himself and his history. Shelly was able to understand more of his behaviors and quirks, as well, and it helped our therapy and their relationship.

Had I known nothing about autism, I could have easily made the mistake of attributing Clark’s personality to the psychological impact of his childhood.

He’s rigid and controlling? Well, life was so unstable with his alcoholic mother.

He’s annoyingly needy? How can you blame him, after all the rejection he’s suffered?

You begin to understand the dangers of clinical ignorance around autism spectrum disorders.

Clark had many previous therapists in his life who were not aware of the signs.

If we lack basic skills to recognize possible ASD, we will never refer clients to the resources they need, and we will keep hitting a neurological disorder with only our psychological hammers.

So what should you watch for?

This list is not exhaustive, but any combination of:

  • A robotic or monotone way of speaking, or a way of speaking that doesn’t feel conversational or customary.
  • Reporting feeling “different” or “alien” throughout life.
  • History of social awkwardness, or being a loner.
  • Reporting sensory overwhelm in crowded, loud, or bright environments. Many autistic people have learned to manage these through the use of headphones, sunglasses, fidgets, and other tools.
  • Difficulty with eye contact. A side note: In conversation with Clark, I mentioned that he had great eye contact. “Aha!” he said. “What’s the first thing I do when I sit down? I take my glasses off. I can look right at you but I can’t really see your eyes. That’s the only way I can handle it. I figured that out years ago.” (Talk about a brilliant coping mechanism!)
  • Ritualized behaviors—which might make you lean diagnostically towards OCD.
  • Fixated, obsessive interests.
  • Difficulty in social interactions. (One ASD woman I counseled used to attend a church group for singles and lamented that socializing was like speaking another language: she could not keep up quickly enough in conversation to react appropriately in time.)
  • Difficulty with empathy. (After a terrifying incident at their children’s school in which teachers thought there was an active shooter, Shelly called to thank the teacher for her bravery. “Why would you do that?” asked Clark, genuinely annoyed. “You don’t thank people for doing their job.”)

If a client has reached adulthood without being diagnosed, he is likely high-functioning, using a number of ingenious coping mechanisms to manage the everyday world.

If you suspect a client might be on the spectrum, do your research—then talk to your client and offer referrals for diagnosis, if they wish.

Many autistic people say that finally being diagnosed as an adult meant finally understanding themselves, after feeling lost and different for so long.

Examples: https://depts.washington.edu/dbpeds/Screening%20Tools/DSM-5(ASD.Guidelines)Feb2013.pdf

https://www.autismspeaks.org/what-autism/diagnosis/dsm-5-diagnostic-criteria


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